Documente Academic
Documente Profesional
Documente Cultură
Khalid Mortaja
29/4/13
We have several diseases and situations that could lead to several manifestations of the oral cavity, they might be local or systematic diseases leading to loss of teeth, discoloration of teeth, connective tissue alterations or epithelial alterations, and well talk about them one by one.
External factors: poor oral hygiene and smoking Internal factors: drugs such as Tetracycline during pregnancy, flurosis, porphyria, jaundice
2) Leading to swelling of gingiva: Local cause: bad dentures, acute and chronic gingivitis, Hyperplastic (Mouth breathers), Tumors Systemic causes: pregnancy, drugs such as Phenytoin and cyclosporine, infiltrative, tumors
Systemic causes: Desquamative gingivitis (its caused by systemic dermatological disease), Herpes Simplex Virus, Vascular abnormalities, Bullous diseases
4) White Patches (Leukoplakia): this type can be premalignant Local causes: friction (not premalignant), smoking (premalignant) Systemic causes: candidiasis, lichen planus, lupus erythematous, chronic renal failure
5)
Leading to pigmentation of gingiva: Racial: usually darker races have darker gingivae Local causes: amalgam tattoo, melanocytic macules )( Systemic causes: endocrine diseases (such as Addisons disease), Kaposi sarcoma, melanoma (malignant tumor of melanocytic nevus), drugs (such as Hydroxychloroquine and minocycline)
6) Leading to ulceration of gingiva: Local causes: any trauma can cause ulcer (most common) Systemic causes: Hematologic diseases: anaemia, leukaemia, neutropenia Gastro Intestinal diseases: celiac disease, inflammatory bowel disease Connective tissue diseases: systemic lupus erythematous, Behcets disease, Sweets syndrome Infections: herpes simplex virus Immunological diseases: bullous pemphigoid, pemphigus vulgaris Drugs: Cytotoxics (used for chemotherapy)
Local causes: burn (drinking hot beverages), mucoceles (cyst fused to the mucin) Systemic causes: pemphigus vulgaris, lichen planus, mucous membrane pemphigoid (these 3 are the most common causes of blistering of gingiva)
Page 5
As you can see in the figure above, the major difference between Desquamative gingivitis and chronic gingivitis is that in the first (DG) there is no involvement of interdental papillae (spared), while the latter (CG) shows involvement of interdental papillae.
Page 6
2) Leading to redness of oral mucosa: Local causes: infections such as herpes simplex virus Systematic causes: Infections: such as candidiasis Inflammatory causes: such as lichen planus, mucos membrane pemphigoid, pemphigus vulgaris Vascular causes: telangiectasia, Kaposi sarcoma Drugs: cytotoxic drugs such as mucositis Other causes: geographical tongue (not related to any disease), nutritional deficiencies such as (folate, iron, vitamin B12)
Redness
3) Leading to ulceration of oral mucosa: Local causes: traumas (most common cause) such as (orthodontic appliances), tumors Systemic causes: Haematological diseases Gastro Intestinal diseases: such as celiac disease and inflammatory bowel disease Dermatological diseases: such as lichen planus and bullous pimphigoid Infections: such as herpes simplex virus Vaculitis Iatrogenic (caused by drugs)
Treatment for RAS: because they are associated with inflammatory diseases we will use anti-inflammatory drugs (Steroids and Colchicine).
4) White Patches (leukoplakia): this type can be premalignant Infective leukoplakia: candida, hairy leukoplakia Systemic causes: lichen planus, lupus erythematous, renal and liver diseases Genetic causes: white sponge nevus
Local causes: burn, mucocele Underlying causes: Pemphigus, Bullous Pemphigoid, Mucous Membrane Pemphigoid
Behcets Syndrome
It is a connective tissue disease. We have major and minor criteria to diagnose it: Major: Oral aphtous (I cant diagnose Behcets syndrome without it) Genital ulcers Skin diseases Ocular diseases CNS diseases Treatment for Behcets syndrome depends on the severity, for mild cases we will use topical steroids, while for severe cases we will use Colchicine and Cyclosporine. Main Morbidity is related to Ocular Disease so always involve an Ophthalmologist.
Lichen planus
It is a dermatological disease, manifested by: plaques distributed all over the body (scalp and mucosa). For mucosa, we have many types of lichen planus and the most important one is the erosive lichen planus, because it can be associated with Squamous Cell Carcinoma. Another thing that can be caused by lichen planus is Desquamative Gingivitis. Treatment for lichen planus: topical steroids, tacrolimus, cyclosporine.
Endocrine diseases
Page 10
Addisons disease: usually associated with hyperpigmentation of oral mucosa, tongue and palate. Congenital hypothyroidism and acromegaly: associated with macroglossia (big tongue). Diabetes mellitus: associated with loosening of teeth, xerostomia, candidiasis Pregnancy: associated with Gingivitis, Epulis.
Hematological diseases
Here we are interested in the involvement of WBCs, either increased or decreased, with ulcers or infections. Hemostasis: associated with bleeding.
Renal diseases
Chronic Renal Failure: associated with Xerostomia, Halitosis, Leukoplakia and bleeding
NOTE: drugs names are for memorization, you have to know the drugs that cause gingival swelling Done by: Khalid Mortaja
Page 11